Archive October 2018 XIX, No. 10

Why Go NPO After Midnight?

It's time to get onboard with the not-so-new approach to pre-op fasting.

Daniel Cook

Daniel Cook, Executive Editor


LIQUID ASSETS Letting patients drink 2 hours before surgery decreases their thirst and anxiety, and improves their strength.

Patients who drink clear fluids up to 2 hours before surgery are less likely to become hypotensive during anesthesia induction or experience PONV in recovery. They’re also happier and more prepared to handle the extreme physical stress of surgery. So why do you continue to starve patients by asking them to stay out of the fridge after the stroke of midnight? Maybe because NPO is a hard habit to break and attempts to alter established routines in surgery are as welcome as an add-on case on a Friday afternoon. Before a holiday weekend. But why settle for the change is hard excuse when improving surgical outcomes and patient satisfaction is as easy as (finally) sending one of surgery’s sacred cows out to pasture?

Established practice

Practice guidelines for pre-op fasting issued by the American Society of Anesthesiologists in 1999 said it was appropriate for patients to drink clear liquids at least 2 hours before elective procedures. The ASA reiterated that recommendation in its latest guideline update issued in 2011.

“The guidelines were never intended to drive a change in practice habits or do away with NPO altogether,” says anesthesiologist Joyce Wahr, MD, director of the University of Minnesota Health Preoperative Assessment Center. “They’re intended to inform about when it’s safe to anesthetize patients without having them aspirate.”

But fear of pulmonary aspiration remains a significant barrier to providers letting patients drink clear liquids before surgery, says TJ Gan, MD, MHS, FRCA, professor and chairman of the department of anesthesiology at Stony Brook (N.Y.) School of Medicine.

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